Preventative antibiotics (prophylaxis) in clean and clean-contaminated ear surgery

Ear surgery, as surgery in general, can be divided into several categories: clean, clean-contaminated, contaminated and dirty surgery. Postoperative complications can include wound infection, discharge from the outer ear canal, labyrinthitis and graft failure. This review aimed to demonstrate whether the use of antibiotic prophylaxis in ear surgery can be helpful in reducing postoperative complications in clean or clean-contaminated surgery. There is no current evidence from randomised controlled trials showing that there is any antibiotic substance, in any regime, which can contribute to reducing complications in any type of clean or clean-contaminated surgical procedure in the ear.

Authors' conclusions: 

There is no strong evidence that the large-scale use of prophylactic antibiotics in clean and clean-contaminated ear surgery is helpful in reducing postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis and graft failure.

Read the full abstract...

This is an update of a Cochrane Review first published in Issue 3, 2004 and previously updated in 2007.

Ear surgery may be performed in the treatment of chronic otitis media, ossicular chain disorders, tympanic membrane perforations and otitis media with effusion. Postoperative infection in ear surgery may result in wound infections, infection of the middle ear or mastoid resulting in discharge from the ear canal, failure of the tympanic membrane to close, or labyrinthitis due to infection in, or adjacent to, the inner ear. These complications may be associated with discomfort and inconvenience for the patient, an increase in morbidity and an increase in the costs of medical care.


To assess the effects of local and/or systemic antibiotics for preventing complications such as postoperative discharge, graft failure and labyrinthitis in patients undergoing clean or clean-contaminated ear surgery.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, Web of Science, BIOSIS Previews, Cambridge Scientific Abstracts, mRCT and additional sources for published and unpublished trials. The date of the most recent search was 31 August 2009.

Selection criteria: 

Randomised or quasi-randomised trials involving patients undergoing clean or clean-contaminated types of ear surgery. Skull base surgery was excluded. We included any regimen of local and/or systemic antibiotic prophylaxis administered at or around the time of surgery compared to placebo, no antibiotic or an alternative intervention group. Outcome measures were infection, discharge, graft failure, labyrinthitis and adverse effects of prophylaxis.

Data collection and analysis: 

When possible, we contacted investigators for additional information on data and methodological issues. At least two authors independently extracted data and assessed trial quality.

Main results: 

Eleven studies were included in the review. The methodological quality of the trials was fair to good. However, most studies presented insufficient methodological detail. Although definitions of outcome measures were heterogeneous, pooling of results was possible. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of postoperative infections, graft failures, draining outer ear canals and adverse drug effects.